Symmetrical Drug-related Intertriginous and Flexural Exanthema (Baboon Syndrome)

Baboon syndrome, also called symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), is an erythematous maculopapular rash that presents in skin folds in a symmetrical pattern. This condition may develop after the patient starts a particular agent. Treatment consists of stopping the associated trigger and medicating with topical or systemic corticosteroids. A 30-year-old man with odynophagia, otalgia and fever was prescribed amoxicillin. He developed erythematous and pruriginous lesions in the cubital fossa and inguinal regions. He attended the emergency department (ED) where he was prescribed penicillin. Lesions continued to progressively worsen with a bilateral symmetrical pattern in the axillary region and later in the nape folds, popliteal regions, and on the perineum and buttocks. The patient presented to the ED for a second time, where he was diagnosed with baboon syndrome and prescribed topical steroids with clear improvement.

Pattern of superficial venous arrangement in cubital fossa among preclinical Nepalese MBBS students at Birat Medical College Teaching Hospital

Background: The superficial veins of the cubital fossa are frequently variable in existence and arrangement. Many clinical procedures, such as reconstructive microsurgery and arterial bypass surgery, as well as intravenous injections or therapy, require the use of superficial veins. Aims and Objective: The aim of the study was to observe and describe the variations in anatomical distribution of the superficial veins of the cubital fossa in Nepalese pre-clinical medical students. Materials and Methods: The cross-sectional study included a total of 98 students between 18 to 24 years of age. A total of 196 anterior aspects of both arms were examined for cubital venous pattern. A tourniquet was applied at the mid-arm and drawing of the pattern of veins was made on a separate unglazed paper. The venous patterns in the cubital fossa were then categorized based on their gender. Results: Six patterns of superficial veins of the cubital fossa were observed. The commonest pattern in both genders was type I pattern. No statistical significant difference was observed between patterns of superficial veins on the right and left cubital fossa (P = 0.728 and 0.825 respectively) in both male and female subjects. Conclusion: Our research showed six venous patterns of superficial veins at the cubital fossa in Nepalese population. Understanding the common anatomy, patterns and variations of superficial vein anastomosis is imperative as this knowledge would help those needing venous access for various medical procedures.

Evaluation of the AirgloveTM, An Air-Regulated Thermal-Venodilatory Device Facilitating the Cannulation of Patients With Difficult Venous Access

Background Difficult venous access (DVA) can prevent delivery of life-saving intravenous (IV) fluids and medication. The Airglove™ was developed to facilitate IV access, circumventing DVA in chemotherapy patients, as current warm-water immersion (WWI) methods are sub-optimal. Methods This study had two parts; EAGLE-1, an observational, proof-of-concept study and EAGLE-2, a prospective, cross-sectional comparative study. EAGLE-1 recruited 80 adult participants undergoing chemotherapy for cancer with DVA where venous cannula insertion success rate was evaluated using Airglove™. EAGLE-2 was carried out on 34 adult healthy participants where the degree of venodilation by WWI and AirGlove™ in three veins; cubital-fossa cephalic vein, cubital-fossa median vein and the third dorsal carpal vein on both arms were measured using the GE Logic S8 multi-frequency linear-array transducer (L6-15MHz), two-dimension B-mode ultrasound. Baseline measurements were taken at 23oC, forearms were warmed to 38oC using the two modalities prior to ultrasound assessment. Results An IV cannulation success-rate of 87.5% was achieved with the Airglove™ in EAGLE-1. The EAGLE-2 study demonstrated significant venodilation enhancement in all veins examined (p < 0.001, 95% C.I) using the Airglove™. BMI, percentage body-fat, age, gender, or blood-pressure did not significantly influence the degree of venodilation. Conclusions Airglove™ enabled a significant percentage of successful cannulations in participants with DVA in EAGLE-1. EAGLE-2 demonstrated that Airglove™ significantly enhanced venodilation compared to WWI. There may be potential for Airglove™ to be considered in specific clinical settings where DVA is encountered.

Patterns of median nerve branching in the cubital fossa: implications for nerve transfers to restore motor function in a paralyzed upper limb

OBJECTIVE The purpose of this study was to describe the anatomy of donor and recipient median nerve motor branches for nerve transfer surgery within the cubital fossa. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS In the cubital fossa, the first branch was always the proximal branch of the pronator teres (PPT), whereas the last one was the anterior interosseous nerve (AIN) and the distal motor branch of the flexor digitorum superficialis (DFDS) on a consistent basis. The PT muscle was also innervated by a distal branch (DPT), which emerged from the anterior side of the median nerve and provided innervation to its deep head. The palmaris longus (PL) motor branch was always the second branch after the PPT, emerging as a single branch together with the flexor carpi radialis (FCR) or the proximal branch of the flexor digitorum superficialis. The FCR motor branch was prone to variations. It originated proximally with the PL branch (35%) or distally with the AIN (35%), and less frequently from the DPT. In 40% of dissections, the FDS was innervated by a single branch (i.e., the DFDS) originating close to the AIN. In 60% of cases, a proximal branch originated together with the PL or FCR. The AIN emerged from the posterior side of the median nerve and had a diameter of 2.3 mm, twice that of other branches. When dissections were performed between the PT and FCR muscles at the FDS arcade, we observed the AIN lying lateral and the DFDS medial to the median nerve. After crossing the FDS arcade, the AIN divided into: 1) a lateral branch to the flexor pollicis longus (FPL), which bifurcated to reach the anterior and posterior surfaces of the FPL; 2) a medial branch, which bifurcated to reach the flexor digitorum profundus (FDP); and 3) a long middle branch to the pronator quadratus. The average numbers of myelinated fibers within each median nerve branch were as follows (values expressed as the mean ± SD): PPT 646 ± 249; DPT 599 ± 150; PL 259 ± 105; FCR 541 ± 199; proximal FDS 435 ± 158; DFDS 376 ± 150; FPL 480 ± 309; first branch to the FDP 397 ± 12; and second branch to the FDP 369 ± 33. CONCLUSIONS The median nerve's branching pattern in the cubital fossa is predictable. The most important variation involves the FCR motor branch. These anatomical findings aid during nerve transfer surgery to restore function when paralysis results from injury to the radial or median nerves, brachial plexus, or spinal cord.

A cadaveric study of brachial artery and its variations with its ontogenic basis: An Anatomical Perspective

Introduction: Conventional knowledge of the brachial artery, the principal artery of the upper limb & its branches has played a major role in vascular surgeries. Literature along with various cadaveric & clinical studies suggest that brachial artery vary widely in origin, course and branching pattern. The great variability of this arterial pattern may be attributed to the failure of regression of some paths of embryonic arterial trunks. Anatomical knowledge of this principal artery and its variations has many clinical implications especially in surgeries related to orthopedic and vascular re-constructive procedures. MATERIALS AND METHODS: The present study was conducted on 56 upper limbs of different age group and sex (19 Male and 9 Female) The brachial arteries were identified and branching pattern and relations of the brachial artery with brachial plexus in arm was observed and presence or absence of variations were documented. Results: Out of 56 upper limbs studies, 53 (94.64%) limbs showed normal morphological pattern of brachial artery, 3 (5.35%) limbs showed superficial brachial artery, 1 limb (1.78%) showed tortuous and SBA with trifurcation into radial artery, ulnar artery and common interosseous artery in the cubital fossa. Conclusion: The study of Brachial artery and variation in its course and branching pattern is clinically important for surgeons, ortho-paedicians operating on the supracondylar fracture of humerus and radiologists performing angiographic studies on the upper limb. KEY WORDS: Common Interosseous Artery, Median Nerve, Superficial Brachial Artery, Trifurcation, Ulnar Artery.

Saphenous Vein Graft between Brachial Artery and Cephalic Vein in Antebrachial Arteriovenous Anastomosis – Simulation of the Procedure

Patients with chronic renal failure and vascular diseases require the vascular access for hemodialysis procedure to be performed with the most possible comfort for the patient. Native vein graft has a longer-lasting term in the patients&rsquo; limb, lower risk of graft infection and lower price. Native vein graft is constructed from the great saphenous vein, if the diameter of the vessel is smaller than the diameters of vessels (brachial artery, cephalic vein) it is connected to in the cubital fossa region due to the risk of graft folding, that might occur, if the graft diameter is bigger than the diameter of one or both vessels, on which anastomosis is made. The most important sizes, that were taken before graft placement, are the length of the forearm compartment, the distance between the brachial artery and cephalic vein in the cubital fossa region, distance from an expected incision in the brachial artery to the middle of the forearm compartment, the distance between incision in cephalic vein to the middle of the forearm compartment, length of the great saphenous vein (the graft) and diameters of blood vessels, used in the procedure. Finally, the right position of the graft should be determined for the successful outcome of anastomosis creating procedure.